How labeling a patient's problem 'impaired consciousness' keeps me objective

Alcoholism affects people from all walks of life. There is no escape from its clutches for those afflicted with the disease. The rich, the poor and everybody in between has their share of alcoholic persons.

Responding to calls to treat intoxicated persons is frustrating, time consuming and has the potential to be the undoing of any well-meaning EMT or paramedic.

Remembering that a 911 call for an intoxicated person is the same thing as a call for a person with an impaired consciousness helped me keep things in perspective, and not judge the people entrusted to my care. When I learned to stop hearing the "intoxicated person" message from dispatch and replaced to words I heard to "impaired consciousness" my frustration diminished greatly.

Ultimately, people suffering from alcoholism deserve the same level of professionalism as everybody else.

Not so healthy
Fleas flutter around the sleeping man, land on his face, his hands, bite him, then fly off.

"Rubin!" I said, crouching down.

He was sixty, looked seventy, wrinkled, tired and just about done.

Sixty years. That's longer than most street people last. They don't have longevity.

Tonight, Rubin is inside, lying on a flea-infested air mattress at one of the state's largest homeless shelters. He considers the place his home. It's where he lays his head at the end of long days spent wandering the streets of Providence. They let him stay here, tucked away in the corner of the day room, along with anywhere from ten to 100 other homeless folks.

At six or seven in the morning, they are all shown the door, left to their own devices for the day. For some, that means looking for work. For most, it means looking for a high: booze, heroin, crack, pills; whatever works. Rubin depends on vodka in little half pints.

"I'm sleeping," Rubin said. "Leave me alone."

"They're kicking you out."

"Why""

"Because you are intoxicated."

He's nearly always intoxicated.

I watch as he closes his eyes and falls back asleep. The fleas return to his face. I brush them off, he swipes at my hand, thinking I'm a giant flea. He misses.

I pull a sleeping bag over his face and leave him where he lies.

The girl at the desk apologizes for calling us, but also lets us know that she's not going to be responsible for him if he gets sick. Or seizes. Or dies.

I tell her to call us back if he wakes up and walk back to the truck.

Rubin returns to his dreams.

Wealthy
At the end of the road, fifty yards from the river on the front steps of a well-maintained home, sits a 60-year-old woman. Her brother stands close by, apologetic and concerned.

"We tried to get her to go, but she won't budge."

The woman stayed seated, defiant. She knew what little control was hers was about to be taken away, and she had no intention of giving it up willingly.

A little dog scurried over. I knelt and scratched behind his ears as the intoxicated woman looked on.

"She's been drinking for 10 days. Says she wants to drink herself to death. My sister is inside getting some things."

I looked her in the eye while petting her dog.

"We're taking you to the hospital."

"Bullshit," she slurred.

One of the firefighters who was on scene before us chimed in.

"We can do this the easy way or the hard way, it's up to you."

I never was a fan of the strong-arm tactic.

"In five minutes we are going to be at the ER. I know you don't want to go but I am required by law to intervene if family members present a strong case that you may harm yourself. And, you are intoxicated, so I can't leave you here."

She tried to rationalize, claim her freedom was being compromised, get up and run, be a rock and simply not cooperate.

Years ago, I would have called police and let the firefighters help me wrestle her and tie her to the stretcher and drag her away from her home. Today, I let go of the dog, took hold of her arm, had my partner take the other and lifted her to her feet. We walked to the stretcher, put her on it and fastened the seat belts. The struggle lasted about 20 seconds.

Then the crying began. She cried all the way to the hospital, taking a break now and then to glare at me, but her resolve was broken, along with her spirit. She did make one desperate lunge for the rear door, but before the seat belt was undone I had her back down.

As I walked out the door of the ER, the woman's sister who had accompanied us in the back of the rescue stopped me. She took my hand and looked me in the eye.

"I want to thank you for being so kind."

She held the gaze for a moment, her eyes filled up and she turned and walked away.

I quickly wiped my own eyes and got back in the truck.

Alcoholism is a crafty, evil disease.

A little too wise
Monday she was drunk at home, a concerned friend called 911 to have strangers check on her well-being. I guess it is easier to call the fire department when a friend is in need than getting up and doing something yourself.

We found her inside her apartment, empty beer cans littering the floor, highly intoxicated. There is no law against being drunk at home, but our patient clearly needed some help.

After a small brawl, we talked her into going to the hospital for detox, hopefully eventual rehab.

Wednesday she was home again, drunk. This time she called 911 for a ride to the hospital because she wanted to go to detox. Apparently, rehab wasn't in the cards on Monday.

Saturday we got a call for an intoxicated person at an address on Broad Street. Our friend, drunk again, this time at an acquaintance's place. He was tired of her, wanted us to get rid of his problem guest.

By now I thought we had become friends with the woman. It's a short trip to the emergency room, but a bond quickly forms between patient and caregiver, especially a frequent customer.

Monday we got a call for a person down in the bushes. I saw a hand rise from some hedges in front of one of the high-rise buildings where the elderly and disabled residents of Providence reside. Walking closer, I saw my newest old friend, drunk again, unable to extricate herself from where she fell.

She fought for a while, learned quickly that a 60-year-old former prostitute is no match for five firefighters sent to help her. "I have a knife," she said, enraged now that we had her out of her nest.

You would think that after all of these years I would learn never to let my guard down. Because familiarity sets in by no means diminishes the potential threat on every call.

To the patients we are sent to treat, we are no more than a blur, a momentary diversion from their otherwise dreary existence. Once we part ways we are forgotten, the next person who enters their lives more important than the last.

She ripped open the front of her coat and brandished a 12-inch butcher's knife. Her eyes were wild, full of hate.

Before she had a chance to hurt herself, or us, we disarmed her, put her on the stretcher and took her to the hospital. There was no real malice once the knife was out of her hands, but for one moment, when she was capable of murder, she could have altered a lot of lives.

These three 60-year-old people have one thing in common. They call it alcoholism.

For me to remain objective, I call it impaired consciousness.

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